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380 PALM ISLAND NORTHEASTU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name JOSEPH W. & KELLY S. TURGEON Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Company NAIC Number: City State ZIP Code CLEARWATER FLORIDA 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 81, UNIT 6B ISLAND ESTATES OF CLEARWATER - PARCEL # 05-29-15-43434-000-0810 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Lat. 27.9855° N. Long. Accessory, etc.) RESIDENTIAL 82.8161° W. Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 10 2 photographs of the building if the Number 7 Certificate is being used to 3,234 sq ft with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b 1633 sq or enclosure(s) within in sq ft within 1.0 foot sq in N/A ❑ Yes x No garage: garage N/A openings in the attached garage in A9.b N/A ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER - 125096 B2. County Name PINELLAS COUNTY B3. State FLORIDA B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 8-18-2009 B7. FIRM Panel Effective/ Revised Date 9-3-2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ CBRS data ❑ NGVD System or base flood depth entered in Item B9: ❑ Other/Source: x FIRM datum used located in a N/A 1988 ❑ Other/Source: or Otherwise Protected 1929 x NAVD (CBRS) area ❑ OPA Area (OPA)? ❑ Yes X No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE i OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V Complete Items C2.a—h below according to the building diagram specified Benchmark Utilized: BROOKSVILLE CORS ARP Vertical x building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, ARAE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. N.A.V.D. 1988 Indicate elevation datum ❑ NGVD 1929 used x for the elevations in items a) through h) below. NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5 , 65 x the measurement used. feet ❑ meters b) Top of the next higher floor 15 75 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N A x feet ❑ meters d) Attached garage (top of slab) N A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N A x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 4 . 8 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5 . 5 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N . A x feet ❑ meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement may be punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? x authorized by law the data available. 1001. Yes ❑ No to I understand x certify elevation information. that any false Check here if attachments. Certifiers Name License Number GEORGE A. SHIMP III 6137 Place ,.`......, sear r' Het.' .-I.., , c :: '• .,:°.tv-. r' . # 613,7�`Date , 42:1'84017 Title Job Number VICE PRESIDENT 080014-H Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DeSOTO BOULEVARD, SUITE D City State ZIP Code PALM HARBOR FLORIDA 34683 (Not valid unless ee bossed with surveyor's original raised seal) Future Date Telephone 4 12-18-2017 727-784-5496 Copyall�of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) SEE ATTACHMENT PAGE 7 OF 7 FOR SURVEYOR'S NOTES AND COMMENTS. THIS DOCUMENT IS NOT VALID UNLESS SIGNED AND EMBOSSED WITH THE SURVEYOR'S ORIGINAL RAISED SEAL AND MUST CONTAIN ALL 7 PAGES. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 4 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a complete Sections A, Band C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments RECEIVED BY: B.V.F. FEB 0 2 2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 380 PALM ISLAND BCP2017-05298A ELEVATION CERTIFICATE KELLY S TURGEON Zoning: Island Estates Atlas #: 258B ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE •• OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8—G10. In Puerto Rico only, enter to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA -issued or community -issued BFE) is provided for community floodplain management purposes. G1. ■ The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. G3. ❑ The following information (Items G4—G10) G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. 11 ® A at • 1 Photo One Photo One Caption FRONT VIEW 12-18-2017 *wit' „4,10,,, Photo Two Photo Two Caption REAR VIEW 12-18-2017 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. Photo One Photo One Photo One Caption N/A Photo Two Photo Two Photo Two Caption N/A FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 ELEVATION CERTIFICATE Surveyor's Notes Attachment Page 7 OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST FOR INSURANCE COMPANY USE Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) Al.) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑X ENCLOSURE 0 ATTACHED GARAGE 0 N/A IF APPLICABLE, THE CRAWLSPACE CONTAINS NIA ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ). IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE, STORAGE, ENTRY, STAIRS & ELEVATOR ). IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? 0 YES ❑x NO 0 N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ). A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, FEMA'S INTERACTIVE MAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.e) NO MACHINERY AND/OR EQUIPMENT HAS BEEN INSTALLED. Attachment Page 7 of 7 RECEIVED BY: S.A. JUN 1 2 2018 PLANNING & DEVELOPMENT CITY CF CLEARWATER 380 PALM ISLAND BCP2017-05298A elev. cert. KELLY S TURGEON Zoning: Island Estates Atlas #: 258B U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. & i' 22/i- 05Z76 OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name JOSEPH W. & KELLY S. TURGEON Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Company NAIC Number: City State ZIP Code CLEARWATER FLORIDA 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 81, UNIT 6B ISLAND ESTATES OF CLEARWATER - PARCEL # 05-29-15-43434-000-0810 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Lat. 27.9855° N. Long. Accessory, etc.) RESIDENTIAL 82.8161° W. Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 17 2 photographs of the building if the Number 7 Certificate is being used to 3,295 sq ft a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b *SEE NOTES sq or enclosure(s) within in sq ft within 1.0 foot sq in N/A x Yes ❑ No garage: garage N/A openings in the attached garage in A9.b N/A ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER - 125096 B2. County Name PINELLAS COUNTY B3. State FLORIDA B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 8-18-2009 B7. FIRM Panel Effective/ Revised Date 9-3-2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ CBRS data ❑ NGVD System or base flood depth entered in Item B9: ❑ Other/Source: x FIRM datum used located in a N/A 1988 ❑ Other/Source: or Otherwise Protected 1929 x NAVD (CBRS) area ❑ OPA Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 8 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ❑ Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. 1988 Cl. Building elevations are based on: ❑ Construction Drawings* x Building Under Construction` *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: BROOKSVILLE CORS ARP Vertical Datum: N.A.V.D. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5.65 Check the measurement used. x feet ❑ meters b) Top of the next higher floor 15.75 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A x feet ❑ meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 15.13 x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 4.8 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.5 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A x feet ❑ meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by I certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No x Check here if attachments. Certifier's Name License Number GEORGE A. SHIMP III 6137 G: , 'r,,' ~7. •' ',s4 • - Hefe !.. `' j''' el ' 4 . .. — Title Job Number VICE PRESIDENT 080014-I Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address• 3301 DeSOTO BOULEVARD, SUITE D '*. i 1 r ,,ilii ` '•••......•.* .'`,' # 6137' Date; ;••tC:7-'2018 City State ZIP Code PALM HARBOR FLORIDA 34683 (Not valid unless errhbossed with surveyor's original raised seal) ture Date Telephone _ 6-7-2018 727-784-5496 Copy all pages of this Elev ion Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) SEE ATTACHMENT PAGES 7 AND 8 FOR SURVEYOR'S NOTES AND COMMENTS. THIS DOCUMENT IS NOT VALID UNLESS SIGNED AND EMBOSSED WITH THE SURVEYOR'S ORIGINAL RAISED SEAL AND MUST CONTAIN ALL 8 PAGES. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 8 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. •❑ b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 8 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 8 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. 91,. , II 1111 1111 IIII u MI - -- _ .,.,.d i aoora.�w Photo One Photo One Caption FRONT VIEW 1 6-7-2018 9 ... "VC_ N' ..r. ftr--`++. 8007282414 44206158 f X, VerteChS ! 4 - aii t '/T I r, t'f�t f , ` Photo Two Photo Two Caption FRONT VIEW 2 6-7-2018 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 8 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. is mg il 4 t NIR • 4li MI •F • Mr 1 !, I IIr - Photo One Photo Three Caption REAR VIEW 1 6-7-2018 ill MI 4 II IRA It$ iil 111 i ..�... ter, ". Photo Two Photo Four Caption REAR VIEW 2 6-7-2018 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 8 • . e • Surveyor's Notes Attachment Page 7 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST FOR INSURANCE COMPANY USE Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) Al.) THIS ELEVATION CERTIFICATE WAS EXCLUSIVELY PREPARED FOR AND CERTIFIED TO THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. UNAUTHORIZED COPIES IN ANY FORM OR BY ANY MEANS, INCLUDING PHOTOCOPYING OR OTHER ELECTRONIC OR MECHANICAL METHODS, ARE STRICTLY PROHIBITED, SHALL NOT BE CONSIDERED AS SIGNED AND SEALED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. IN REGARD TO THE ENGINEERED FLOOD OPENING(S), IF APPLICABLE, THE SURVEYOR DOES NOT KEEP COPIES OF EITHER THE INDIVIDUAL ENGINEERED FLOOD OPENINGS CERTIFICATION OR THE EVALUATION REPORT ISSUED BY THE INTERNATIONAL CODE COUNCIL EVALUATION SERVICE (ICC ES) ON FILE. CURRENT COPIES OF THESE DOCUMENTS SHOULD BE AVAILABLE FROM THE MANUFACTURER OF THE ENGINEERED FLOOD OPENING(S). B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, FEMA'S INTERACTIVE MAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. B9.) IF APPLICABLE, WHEN THE BASE FLOOD ELEVATION IS SHOWN AS A WHOLE NUMBER ON THE FIRM, IT HAS BEEN CONVERTED TO A DECIMAL AND ENTERED TO THE NEAREST TENTH OF A FOOT AS REQUIRED BY FEMA. IF APPLICABLE, THE STRUCTURE CONTAINS: 0 CRAWLSPACE 0 ENCLOSURE 0 ATTACHED GARAGE 0 N/A IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE, STORAGE AREA, ENTRY, STAIRS & ELEVATOR IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? 0 YES 0 NO 0 N/A IF APPLICABLE, THIS ELEVATION CERTIFICATE WAS PREPARED USING THE "HISTORIC" FLOOD MAP DATA AND DATUM (N.G.V.D. 1929) FOR POSSIBLE "GRANDFATHERING" PURPOSES: 0 YES 0 NO Attachment Page 7 of 8 ELEVATION CERTIFICATE Surveyor's Notes Attachment Page 8 • OMB No. 1660-0008 Expiration Date: November 30, 2018 ,. , IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 380 PALM ISLAND NORTHEAST Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 7) IN REGARD TO ENGINEERED FLOOD OPENING(S), IF APPLICABLE, THE STRUCTURE'S: ❑ CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES, PROVIDING COVERAGE FORA TOTAL OF N/A SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED ❑UNDER CONSTRUCTION 0 PER PLAN p N/A NOTES: N/A 0 ENCLOSURE CONTAINS 17 ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER 200 SQ. FEET PER OPENING (MANUFACTURER: SMART VENT — MODEL: 1540-520 ) FOR A TOTAL OF 3,400 SQ. FEET OF COVERAGE AND 0 NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF 0 SQ. INCHES, PROVIDING COVERAGE FOR A TOTAL OF 3,400 SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: 0 INSTALLED 0 UNDER CONSTRUCTION OPER PLAN 0 N/A NOTES: N/A ❑ ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED ❑UNDER CONSTRUCTION 0 PER PLAN 1 N/A NOTES: N/A C2.e) WOOD AIR CONDITIONER DECK ON SIDE OF BUILDING (NO MACHINERY AND/OR EQUIPMENT HAS BEEN INSTALLED.) Attachment Page 8 of 8